can architectural space be heali...the “helende arkitektur” (“healing architecture”) project...

CAN ARCHITECTURAL SPACE BE HEALING?

A VIRTUAL STRESS EXPERIMENT

L A R S B R O R S O N F I C H

C A N D . A R C H . M A A . P H . D .

Background:

Background:

1984 Graduated as an architect

Background:

1984 Graduated as an architect

1984 – 2008

Worked at an architectural office

1998– 2008 as a partner.

.

Background:

1984 Graduated as an architect

1984 – 2008

Worked at an architectural office

1998– 2008 as a partner.

2007 – 2008 Project manager; ICU

Background:

1984 Graduated as an architect

1984 – 2008

Worked at an architectural office

1998– 2008 as a partner.

2007 – 2008 Project manager; ICU

2008 –

Aalborg University

Background:

1984 Graduated as an architect

1984 – 2008

Worked at an architectural office

1998– 2008 as a partner.

2007 – 2008 Project manager; ICU

2008 –

Aalborg University

Background:

2007 – 2008 Project manager; ICU

2008 – 2009

The “Helende Arkitektur” (“Healing

Architecture”) Project in cooperation

with Aalborg University.

Background:

2007 – 2008 Project manager; ICU

2008 – 2009

The “Helende Arkitektur” (“Healing

Architecture”) Project in cooperation

with Aalborg University.

A review report of approx.. 200

articles how hospital design might

influences treatment, patient and

staff safety, way-finding in hospitals

etc.

Background:

Ulrich, 1984

Patients who had undergone gall

bladder surgery

Background:

Ulrich, 1984

Patients who had undergone gall

bladder surgery

Identical patient rooms

Background:

Ulrich, 1984

Patients who had undergone gall

bladder surgery

Identical patient rooms

Background:

Ulrich, 1984

Patients who had undergone gall

bladder surgery

Tree-group vs. wall-group:

Hospitalized 7.96 vs. 8.70 days

Identical patient rooms

Background:

Ulrich, 1984

Because the patient rooms are

identical, no data about the

architecture itself is produced.

Identical patient rooms

Background:

Ulrich, 1984

Because the patient rooms are

identical, no data about the

architecture itself is produced.

Although the effect is assumed to be

connected to stress and anxiety, there

is no physiological measure.

Identical patient rooms

Background:

Ulrich, 1984

Can the architecture itself influence

the healing process by way of the

stress system?

Identical patient rooms

Background:

Ulrich, 1984

Can the architecture itself influence

the healing process by way of the

stress system?

• Architecture must be the variable

Identical patient rooms

Background:

Ulrich, 1984

Can the architecture itself influence

the healing process by way of the

stress system?

• Architecture must be the variable

• Data must be physiological.

Identical patient rooms

The Trier Social Stress Test (TSST)

Psychosocial stress

Kirschbaum, et al.,1993.

The Trier Social Stress Test (TSST)

Psychosocial stress

Lab set-up:

• Preparation room

• Test room (committee)

Kirschbaum, et al.,1993.

The Trier Social Stress Test (TSST)

Protocol:

• 5 min. baseline recording

Kirschbaum, et al.,1993.

The Trier Social Stress Test (TSST)

Protocol:

• 5 min. baseline recording

• Presentation of the assignments

by the committee

Kirschbaum, et al.,1993.

The Trier Social Stress Test (TSST)

Protocol:

• 5 min. baseline recording

• Presentation of the assignments

by the committee

• 5 min. preparation of an oral

presentation

Kirschbaum, et al.,1993.

The Trier Social Stress Test (TSST)

Protocol:

• 5 min. baseline recording

• Presentation of the assignments

by the committee

• 5 min. preparation of an oral

presentation

• 5 min. oral presentation in front of

the committee

Kirschbaum, et al.,1993.

The Trier Social Stress Test (TSST)

Protocol:

• 5 min. baseline recording

• Presentation of the assignments

by the committee

• 5 min. preparation of an oral

presentation

• 5 min. oral presentation in front of

the committee

• 5 min. second assignment:

counting backwards from 1687 in

steps of 13

Kirschbaum, et al.,1993.

The Trier Social Stress Test (TSST)

Protocol:

• 5 min. baseline recording

• Presentation of the assignments

by the committee

• 5 min. preparation of an oral

presentation

• 5 min. oral presentation in front of

the committee

• 5 min. second assignment:

counting backwards from 1687 in

steps of 13

• 40 min. relaxation in the

preparation room Kirschbaum, et al.,1993.

The Virtual Trier Social Stress Test (VR-TSST)

Protocol:

• 5 min. baseline recording

• Presentation of the assignments

by the committee

• 5 min. preparation of an oral

presentation

• 5 min. oral presentation in front of

the committee

• 5 min. second assignment:

counting backwards from 1687 in

steps of 13

• 40 min. relaxation in the

preparation room Jönsson et al., 2010

• Architecture must be the variable

The Virtual Trier Social Stress Test (VR-TSST)

Data:

• Heart rate variability as a measure

of sympathetic (SNS)- and

parasympathetic (PNS) nervous

system activity.

• Saliva samples as a measure of

cortisol release by the HPA-axis.

Jönsson et al., 2010

• Architecture must be the variable

• Data must be physiological.

The Virtual Trier Social Stress Test (VR-TSST)

Fich et al. 2014

Enclosure. Space with openings, potentially

allowing for escape.

The Virtual Trier Social Stress Test (VR-TSST)

Fich et al. 2014

Solid curve = closed room

Dotted curve = open room

Results:

The Virtual Trier Social Stress Test (VR-TSST)

Heart rate

Fich et al. 2014

Data:

• Heart rate variability as a measure

of sympathetic (SNS)- and

parasympathetic (PNS) nervous

system activity.

Results:

The Virtual Trier Social Stress Test (VR-TSST)

SNS

Heart rate

Fich et al. 2014

Data:

• Heart rate variability as a measure

of sympathetic (SNS)- and

parasympathetic (PNS) nervous

system activity.

Results:

The Virtual Trier Social Stress Test (VR-TSST)

SNS PNS

Heart rate

Fich et al. 2014

Data:

• Heart rate variability as a measure

of sympathetic (SNS)- and

parasympathetic (PNS) nervous

system activity.

Results:

The Virtual Trier Social Stress Test (VR-TSST)

cortisol

SNS PNS

Heart rate

Fich et al. 2014

Results:

Data:

• Heart rate variability as a measure

of sympathetic (SNS)- and

parasympathetic (PNS) nervous

system activity.

• Saliva samples as a measure of

cortisol release by the HPA-axis

The Virtual Trier Social Stress Test (VR-TSST)

cortisol

SNS PNS

Heart rate

Fich et al. 2014

Results:

• No part of the autonomous

nervous system was sensitive to

the spatial context.

Results:

The Virtual Trier Social Stress Test (VR-TSST)

cortisol

SNS PNS

Heart rate

Fich et al. 2014

Results:

• No part of the autonomous

nervous system was sensitive to

the spatial context.

• The reaction of the HPA-axis did

react with a less pronounced

stress reaction in the room with

openings as predicted.

Results:

The Virtual Trier Social Stress Test (VR-TSST)

cortisol

SNS PNS

Heart rate

Fich et al. 2014

Conclusion:

• No part of the autonomous

nervous system was sensitive to

the spatial context.

The fight-or-flight reaction can

therefor not be responsible for

the effect.

Results:

The Virtual Trier Social Stress Test (VR-TSST)

cortisol

SNS PNS

Heart rate

Fich et al. 2014

Discussion:

We hypothesize, that the effect is

due the role of the hippocampus as:

• The hippocampus is part of the

HPA feed-back mechanism.

• The hippocampus is mapping

space boundaries.

Results:

The Virtual Trier Social Stress Test (VR-TSST)

cortisol

SNS PNS

Heart rate

Fich et al. 2014

Discussion:

The difference in cortisol is most

pronounced after the TSST, when

the SNS reaction is terminated.

It could be, that the SNS

‘counterbalances’ the reaction of

the HPA-axis.

Results:

The Virtual Trier Social Stress Test (VR-TSST)

cortisol

SNS PNS

Heart rate

Fich et al. 2014

Discussion:

Treatment or examination in a

space with potential possibilities for

“escape” might result in a lower

cortisol level after treatment.

Results:

Kirschbaum, C., Pirke, K-M., Hellhammer, D.H., 1993. The ’Trier Social Stress Test’: A Tool for Investigating Psychobiological

Stress Responses in a Laboratory Setting. Neuropsychobiology, 28, pp. 76-88

Jönsson, P., Wallergård, M., Österberg, K., Hansen, Å.M., Johansson, G., Karlson, B., 2010. Cardiovascular and cortisol

reactivity and habituation to a virtual reality version of the Trier Social Stress Test: A pilot study. Psychoneuroendocrinology,

35, 1397-1403

Fich, L.B., Jönsson, P., Kirtkegaard, P.H., Wallergård, M., Garde, A.H., Hansen, Å., 2014. Can architectural design alter the

physiological reaction to psychosocial stress? A virtual TSST experiment. Physiology & Behavior 135, pp. 91-97

Ulrich, R., 1984. View through a Window May Influence Recovery from Surgery. Science 224(4647) pp. 420-421.

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